Darin Gordon, TennCare director, speaks to legislators in the legislative lounge of the Capitol on Tuesday. / John Partipilo / The Tennessean

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State Rep. Jeremy Durham, R-Franklin, speaks to Andrew Ogles, state director of Americans for Prosperity, during a debate in Legislative Plaza on Wednesday, Feb. 12, 2014, over TennCare expansion. / John Partipilo / The Tennessean

Gov. Bill Haslam

ANALYSIS

Darin Gordon seemed exasperated. The director of TennCare, the state’s Medicaid program, last week agreed to brief House Democrats in the ornate legislative lounge at the Capitol.

Gordon has been Tennessee’s point man with the U.S. Department of Health and Human Services since Gov. Phil Bredesen was in office, and Democrats were eager to pin him down on how — or even if — Gov. Bill Haslam plans to expand TennCare. The questions were often pointed, the conversation often went in circles, and Gordon was often defensive.

“I wish I could convey all the time and energy we’re spending in trying to figure this out,” Gordon said wearily.

The most obvious way Gordon could get that point across would be for his Republican boss to present a plan to expand TennCare that has been blessed by federal officials. But after nearly a year of talks, there are no signs of a breakthrough.

Democrats, who ardently want Haslam to offer TennCare coverage to 175,000 more Tennesseans as called for in the Affordable Care Act, doubt Gordon and the rest of the Haslam administration can reach a deal this year. Republicans who oppose expansion appear even more confident they won’t.

In March 2013, Haslam stood before the General Assembly and announced he would seek federal approval for a “Tennessee Plan” to expand TennCare coverage. The governor said he wants newcomers to the program to receive coverage modeled after private insurance, an approach that would protect the state from escalating health care costs down the road.

Haslam’s announcement had the effect of buying him more time by heading off bills that would have tied his hands. But a year later, the sell may have simply become harder.

As Haslam and Gordon tell it, the Tennessee Plan has been bogged down by details. The Haslam administration wants restrictions and requirements like the privately insured face. Federal officials insist coverage must be as good as Medicaid recipients get.

Haslam has not opposed the measure, saying he intends to ask for the legislature’s blessing anyway. It’s a pragmatic stance. The alternatives include state Sen. Mae Beavers’ proposed Health Care Freedom and ACA Noncompliance Act, which would ban expansion outright.

Still, the bill would have the effect of slowing TennCare expansion, if not making it politically impossible, because it would require a high-profile vote on any Tennessee Plan. Such a proposal would need to materialize shortly for there to be any chance of that happening before lawmakers adjourn in April.

It’s no more likely Haslam would call lawmakers back to take such a vote in a special session this summer. Presenting the Tennessee Plan before the August primary would force GOP lawmakers to choose between their governor and voters who want nothing to do with Obamacare.

It might make sense politically for Haslam to release a Tennessee Plan in the fall, when newly renominated Republicans in close races could support TennCare expansion to buffer themselves against Democratic claims that they’re too extreme. Yet, with AFP putting its weight against expansion, that would be a dicey maneuver.

With each day that passes, the odds increase that Tennessee will miss out entirely on the first of the three years in which the federal government would pay the full cost of expansion, a loss of about $1 billion according to estimates from legislative staff. Democrats have been quick to argue that the missed opportunity has hurt Tennessee’s economy, not to mention its health.

Gordon did his best to convince them last week that Haslam hasn’t been wasting time with the Tennessee Plan. But time has not been working in the governor’s favor.